| NPI | 1528589017 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: TX 9183-TG) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: GA OPT003032) |
| Enumeration Date | 2017-07-05 |
| Last Update Date | 2022-07-18 |